Keep On Walking: Correlations among Life Styles and Successful Aging in Taiwanese Older Women
Chih-Hsun, Wu, Chun-Wei, Chiang,
Yu-Hsuan , Lin, Baai-Shyun, Hurng
Population and Health Research Center
Bureau of Health Promotion,
Department of Health, Taiwan
24th REVES, May 25-27
BACKGROUND
2
Successful Aging
3
Rowe & Kahn (1987, 1997, 1998)
Avoid Disease and
Disability
High Cognitive &
Physical Function
Engagement with Life
Successful Aging
Too narrow, didn’t include the dynamic of the life process
~e.g. Schiedt et al., 1999
A “calculable gold standard of aging”
~Dillaway & Byrnes, 2009
Hierarchical
Operational Definition
Two studies using the HRS and SHARE data operationally defined successful aging as fitting all following 5 criteria:
1. No Major Disease
2. No Disability
3. High Physical Functioning
4. High Cognitive Functioning
5. Active Social Engagement HRS： McLaughlin, et al., 2010
SHARE： Hank, 2010
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Results From Previous Study
Wu, Lin, & Hurng (2011):
Following the operational definition by
McLaughlin et al(2010) and Hank (2010)
Using the data from 2 waves of National Health Interview Survey(NHIS) in Taiwan
2005 NHIS: n = 2,432
2009 NHIS: n = 2,617
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Percentages of Taiwanese Older Adults Meeting Each Individual Successful Aging Criterion by Year and Compared to Other Country
Taiwan USA Europe Denmark Poland Sweden German
2005 2009
Criterion %(n) %(n) % % % % % %
Successful Aging 17.3 (398)
18.2 (425)
10.9 8.5 21.1 1.6 17.4 11.6
No
Major Disease 52.1
(1244) 56.3
(1438) 37.0 42.6 51.0 25.5 45.2 47.5
No
Disability 90.9
(2207) 88.1
(2305) 82.1 83.7 85.9 67.0 86.8 84.2
High Physical
Functioning 65.3
(1575) 68.2
(1714) 49.0 57.3 69.4 31.1 69.4 61.4
High Cognitive
Functioning 56.7
(1326) 56.4
(1347) 57.8 48.5 67.2 30.5 63.4 67.5
Active
Engagement 54.5
(1314) 49.2
(1266) 49.7 27.1 42.6 17.1 39.7 27.4
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Prevalence Of Successful Aging by Demographic and Year
2005 2009 Characteristic n % n % Age, years
65-74 307 21.5 352 25.1 75-84 86 11.2 69 8.3 ≥ 85 5 4.7 4 4.1
Gender Male 275 23.6 255 23.0 Female 123 10.6 170 13.7
Education Elementary school or lesser 265 14.7 255 14.7 Junior High 51 25.3 57 25.3 Senior High 41 29.1 61 28.4 College or higher 41 24.3 52 26.4
Marital Status Married 315 20.9 345 22.0 Divorced/Separated 6 17.4 6 16.3 Widowed 71 9.7 73 11.0 Never Married 6 9.8 1 0.0
Household Income (per month) < 30,000 N.T. 202 16.4 147 12.4 30,000~70,000 N.T. 122 19.9 93 21.7 > 70,000 N.T. 51 21.1 54 33.0
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Female Disadvantage ?
Women were found advantage while considering successful aging
USA: Strawbridge et al (2002)
Singapore: Ng et al. (2009)
Women lives longer than man
But not healthier ????
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Adjusted ORs for Successful Aging by Demographic Criteria
2005 2009
Variables OR p (95%CI) OR p (95%CI)
Age, years (ref 65-74)
≥ 75 0.38 .000 (0.29, 0.50) 0.23 .000 (0.18, 0.31)
Sex (ref male)
Female 0.35 .000 (0.26, 0.46) 0.42 .000 (0.31, 0.55)
Education (ref elementary)
Junior High 1.67 .020 (1.08, 2.57) 1.54 .039 (1.02, 2.31)
Senior High 1.51 .094 (0.93, 2.45) 1.53 .038 (1.02, 2.27)
College or higher 1.27 .276 (0.83, 1.93) 1.39 .136 (0.90, 2.13)
Sex X Education .042 .001
By Sex (ref elementary)
Male Junior High 1.65 .022 (1.08, 2.54) 1.52 .043 (1.01, 2.29)
Senior High 1.51 .095 (0.93, 1.84) 1.52 .038 (1.02, 2.27)
College or higher 1.26 .289 (0.82, 1.92) 1.36 .195 (0.89, 2.09)
Female Junior High 1.81 .125 (0.85, 3.87) 2.84 .000 (1.65, 4.88)
Senior High 4.77 .000 (2.21, 10.28) 3.08 .000 (2.91, 6.71)
College or higher 3.29 .016 (1.25, 8.63) 5.18 .000 (2.89, 9.28)
By Education (ref male)
Elementary Female 0.35 .000 (0.26, 0.46) 0.42 .000 (0.32, 0.55)
Junior High Female 0.36 .016 (0.16, 0.83) 0.73 .316 (0.39, 1.36)
Senior High Female 1.00 .998 (0.43, 2.31) 0.82 .553 (0.42, 1.58)
College or higher Female 0.86 .769 (0.31, 2.37) 1.45 .297 (0.72, 2.92)
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Aim of the Study
To explore the correlations among health behaviors and successful aging in Taiwanese older women
1. Taiwanese older women were less successful aged than men did, and education might be part of the reason
2. Education Level Life Styles
Life Styles Successful Aging
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METHOD
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PARTICIPANTS
2009 National Health Interview Survey(NHIS)
Female
Age ≥ 65
N = 1,474
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Definition of Successful Aging
No Major Disease (Disease=0)
Cancer
Chronic Lung Disease
DM
Heart Disease
Stroke
Depression (CESD≥10)
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Definition of Successful Aging
No Disability (ADL=0) Bathing
Dressing
Toileting
Walking Across a Room
In/Out Bed
Eating
High Cognitive Functioning (MMSE)
(Score ≥ Median 24)
14
Definition of Successful Aging
High Physical Functioning
(Functional Problems ≤ 1) Stooping, kneeling, crouching Walking from room to room Climbing one flight of stairs Walking 400m Finger grasping Lifting items >4.5kg with one hand Raising both arms overhead Holding and turn keys to unlock
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Definition of Successful Aging
Active Social Engagement (Fit both Criteria A+B)
Active Engagement Criteria A (At least 1)
Paid work
Volunteer work
Caring children
Active Engagement Criteria B (At least 1)
Married
Connected with friend
Connected with neighbors
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Independent Variables
Age & Education
Health Behaviors
Drinking
Smoking
Betel Chewing
Exercise
Walking
Physical Labor
How often did you drink in the past year?
Have you ever smoked for over 100 cigarettes ?
Have you ever chewed betel nuts ?
Did you exercise in past 2 wks? How many times?
Did you do any physical laboring works
in past 2 wks? How many times?
Besides exercise and physical labor, did you walk
continuously for at least 10minutes in past 2 wks?
How many times?
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Analysis
Descriptive Statistics
Simple Logistic Regression
Multivariate Logistic Regression
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RESULTS
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Prevalence and Unadjusted ORs of Successful Aging by Demographic and Health Behavior
Total Successful Aging
n n % OR 95% CI
Age 65-74 909 153 19.3 1
≧75 565 17 4.1 0.23 (0.14, 0.38)
Education Elementary 1258 116 10.3 1
High School 160 39 25.2 2.61 (1.68, 4.05)
College 42 15 41.9 3.33 (1.78, 6.23)
Drinking Never 39 3 6.9 1
≤ 1 time /wk 1315 138 11.9 2.04 (1.25, 3.32)
> 1 time /wk 120 29 32.0 0.60 (0.15, 2.49)
Smoking Non-Smoker 1417 168 14.0 1
Smoker 57 2 2.3 0.31 (0.04, 2.57)
Betel Non-chewer 1428 169 13.9 1
Chewer 46 1 1.2 0.13 (0.00, 6.67)
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Prevalence and Unadjusted ORs of Successful Aging by Demographic and Health Behavior
Total Successful Aging
n n % OR 95% CI
Physical Labor
No 1202 128 13.2 1
Yes 250 41 16.8 1.26 (0.81, 1.97)
Exercise
No 743 52 7.0 1
1-6 times/ per 2 wks 103 19 18.4 3.04 (1.32, 5.38)
≥ 7 times/ per 2 wks 603 98 16.3 2.61 (1.83, 3.71)
Walking
No 767 65 8.8 1
1-6 times/ per 2 wks 186 24 13.8 1.60 (0.97, 2.63)
≥ 7 times/ per 2 wks 489 78 20.0 2.05 (1.44, 2.91)
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Exercise + Walking
Exercise
Did you exercise continuously for at least 10minutes in the past 2 wks?
How many times?
Walking
Besides exercise and physical labor, did you walk continuously for at least 10minutes in past 2 wks?
How many times?
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Adjusted ORs of Successful Aging All (n= 1,425) Didn’t Exercise (n = 743)
ORs 95%CI ORs 95%CI
Age 65-74 1 1
≧75 0.19 0.11 0.33 0.14 0.06 0.37
Education Elementary 1
High School 2.75 1.78 4.26 1.27 0.45 3.59
College 3.38 1.65 6.94 5.09 0.84 30.96
Drinking Never
≤ 1 time /wk 2.46 0.67 9.08 NA
> 1 time /wk 1.48 0.43 5.07 NA
Physical labor No 1 1
Yes 1.47 0.98 2.21 1.64 0.84 3.21
Exercise No 1
1-6 times/ per 2 wks 1.89 1.03 3.48
≥ 7 times/ per 2 wks 1.92 1.32 2.78
Walking No 1
1-6 times/ per 2 wks 0.46 0.13 1.65
≥ 7 times/ per 2 wks 2.03 1.09 3.76
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Type of Exercise
0%
10%
20%
30%
40%
50%
60%
70%
walking gymnastic handswing
cycling hiking qi-kung yuan-ki mountainclimbing
61,2%
16,2%
7,9% 7,2% 5,5% 4,7% 4,4% 2,8%
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Results: Summary
Simple Logistic Regression
Exercise (Yes vs. No)
Walking (More than 7days in 2wks vs. No)
Drinking (Less than once a week vs. Never)
Has higher probability of being successful aged
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Results: Summary
Multivariate Logistic Regression
Exercise
About 1.9 times higher in probability of aging successfully for those who exercises than those who didn’t
Most older women’s exercise were walking (61%)
Walking
Those who didn’t exercise
Walks continuously ≥ 10minutes, ≥ 7days in 2wks
About 2 time higher in probability of aging successfully
26
DISCUSSION
27
Discussion
For Taiwanese women older than 65 years old
Exercise was a protective factor of
successful aging
For those who didn’t exercise, walking was a protective factor of successful aging
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Exercising + Walking by Age
0%
10%
20%
30%
40%
50%
60%
70%
65-6970-74
75-7980-
54,9% 53,1%
42,7%
36,7%
13,7% 12,8%
16,6%
11,7% Walking
Exercising
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Discussion
No matter you “planned to exercise”
or “forced to walk”
it’s all better than not moving
30
Keep Moving
Discussion
However, it’s only correlations
Couldn’t infer that
Is it exercising (walking) that raised the probability to age successfully ?
Or, is it the ability to exercise (to walk) might be a good index for successful aging ?
31
Following Question: 1
For those who supposed to have the ability to walk, are there any differences among successful aging criteria between those who did physical activity (exercising + walking) or not ?
Include participants with intact ADL (n = 1,265)
Stratified by age group
Comparing other four successful criteria
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For Those Without Disability……
52%
70% 73%
60% 67%
86% 85%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No Disease HPF HCF Engage
65-69
***
*** ***
51%
36%
62%
33%
54%
67%
75%
47%
0%
10%
20%
30%
40%
50%
60%
70%
80%
No Disease HPF HCF Engage
75-79 ***
***
49% 48%
69%
54%
64%
73% 78%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
No Disease HPF HCF Engage
70-74
*** ***
45%
32%
46%
19%
49%
54% 56%
33%
0%
10%
20%
30%
40%
50%
60%
No Disease HPF HCF Engage
80+ ***
***
Exercise + Walking Yes
No
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Following Question: 1
The results showed that those who did exercising or walking, were having higher probability of filling other successful criteria.
34
No Disease High Physical Functioning
High Cognitive Functioning
Active Social Engagement
65-69 *** *** ***
70-74 *** ***
75-79 *** ***
80+ *** ***
Following Question: 2
Could exercising predicts successful aging ?
A Preliminary Analysis using TLSA
Taiwan Longitudinal Study of Aging (TLSA)
Exercise in 1999 Successful Aging in 2007 Exercise: how many times have you exercise in a week?
Inclusion criteria
Women
High Physical Function in 1999
No missing data
35
Age(‘99)X Exercise(‘99) X Successful Aging (‘07)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Success Physical Disable Disease Cognitive Social
14%
65%
96%
53%
40%
56%
19%
65%
96%
53% 58%
47%
64 years old or younger
No Yes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Success Physical Disable Disease Cognitive Social
0%
33%
88%
39%
32%
21%
10%
53%
92%
50%
40%
24%
65 -69 years old
No Yes
**
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Age(‘99)X Exercise(‘99) X Successful Aging (‘07)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Success Physical Disable Disease Cognitive Social
3%
23%
77%
45%
22%
13%
3%
35%
85%
46%
33%
13%
70-74 years old
No Yes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Success Physical Disable Disease Cognitive Social
0%
17%
87%
57%
15%
9%
0%
22%
74%
54%
11% 10%
75 years old or older
No Yes
37
Following Question: 2
Those who exercises seems perform better in 8 years follow-up although most weren’t statistically significant
the only significance were on HPF in the 65-69 years old group
Need more evidence to clarify: if exercising could predicts successful aging.
38
Limitation
Cross-sectional data
Lack of objective measurement of physical function (e.g. walking speed, etc.)
Lack of subjective measurement of life quality
39
Future Research Directions
Looking into the differences among concepts of aging well (e.g. successful aging, healthy aging, active aging etc.) on health related issues
Exploring longitudinal data (i.e. TLSA) to Further examine predictors of aging well
To explore the correlations among the trend of life style and aging well
Examine if, for instance, “Successful ager” live longer, healthier and had better quality of life ?
40
The Message
41
KEEP MOVING ~~
KEEP WALKING ~~
THANK YOU FOR YOUR ATTENTION
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